Organizational flow chart of home care for children with special health care needs

Rossetto, Vanessa; Toso, Beatriz Rosana Gonçalves de Oliveira; Rodrigues, Rosa Maria

doi:10.1590/0034-7167-2019-0310

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0310 copy

Organizational flow chart of home care for children with special health care needs

Organigrama de atención domiciliaria a niños con necesidades de salud especiales

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana.

Method:

Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart.

Results:

Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed.

Conclusion:

The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.

Descriptors:
Child Health; Chronic Disease; Protocols; Homebound Persons; Pediatric Nursing

Favorable aspects	Unfavorable aspects
Organization of work in the unit
Presence of MHCT in most HCS; Own telephone line; HCS car available without prior arrangement; Accountability of the caregivers, with a consent form; Work developed in a multiprofessional team, with exchange of experiences and construction of strategies based on the perspectives of the different professionals, aiming at a comprehensive approach.	Working hours only on day shifts and not exceeding 12 hours on most HCS; Telephone service carried out by professionals who are mostly unqualified to provide guidance; Most transportations without monitoring from HCS professionals; In the majority of hospitals, there is no training provided by MHCT professionals with a higher education degree, and in the presence of hospital service staff; Lack of standardization for caregiver training; Lack of standardization of the HCS admission routine - reports made, use of forms, definition of the professionals responsible for the admission, information in the term of responsibility, therapeutic program, flow for contact with primary care, home medical records; Lack of standardization of the first consultations, with definition of who performs the follow-up and how often it occurs in the first weeks; Low utilization of the Singular Therapeutic Program (STP).
Organization of work in the territory
Criteria for follow-up on HC1, HC2, or HC3 are established in an ordinance.	There is no specific organization for the care of CSHCN in the territory; Insufficient number of HCS in Parana.
Management flows in the network
Referral to the HCS not lefted on the figure of the physician, mostly; Diverse and decentralized referral sources; Formal moment of transfer of care for HC1 in some HCS; Planned hospital discharge, mostly; There is a national care network model for chronic diseases.	Lack of standardization of professionals who refer to HCS; In the majority of hospitals, there is no training provided by MHCT professionals with a higher education degree, and in the presence of hospital service staff Inconstant communication between HCS and primary care in most of the services; Discontinuation of follow-up in primary care of individuals followed in HCS in most cities; Failure to agree on a specific flow for HCS with the emergency care network.
Evaluation processes (for eligibility)
Evaluation of eligibility not lefted on the figure of the physician in some HCS.	Lack of standardization of professionals who assess eligibility; Time limitation for eligibility assessment not standardized among HCS; Lack of standardization of the factors included in the eligibility assessment (identification of the caregiver, assessment of their ability to perform the necessary procedures at home, acceptance of home care by the caregiver, in-home evaluation and organization of patient transfer to home care); Lack of standardization of caregiver skills assessment - understanding and execution of procedures for eligibility and during follow-up.
Information system
National e-SUS information system available for use in states and cities.	Information systems do not communicate with other units; Referral to home care depends on a time-consuming process; Insufficient implementation of electronic and interconnected medical records.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Vanessa Rossetto. E-mail: vanessa_rosseto@msn.com

INTERNAL FACTORS	Strenghts	Organization of work in the unit	Organization of work in the territory	Management flows in the network	Evaluation processes	Information Systems
	Strenghts	• Presence of MHCT in most HCS. • Owntelephoneline. • HCS cars available without prior arrangement. • Accountability of the caregivers, with a consent form. • Work developed in a multiprofessional team.	• Response time when staff is requested is not standardized, but is established within teams and is considered appropriate.	• Referral not centered on the figure of the physician. • Diverse and decentralized referral sources. • Formal meeting for the transfer of care for HC1. • Planned hospital discharge.	• Evaluation of eligibility not centered on the figure of the physician.	• Existence of computer equipment. • Existence of internet network.
	Weakness	• Working hours only on day shifts and not exceeding 12 hours on most HCS. • Telephone service carried out by professionals who are unqualified to provide definitive guidance. • Lack of standardization of the admission routine. • Lack of standardization of the first consultations. • Low utilization of the STP. • Most transportations carried out without monitoring from HCS professionals. • Lack of standardization for caregiver training.	• Insufficient number of HCS in Parana, considering the rates of child morbidity.	• Lack of standardization of professionals who refer to HCS. • In the majority of hospitals, there is no training provided by MHCT professionals with a higher education degree, and in the presence of hospital service staff.	• Time limitation for eligibility assessment not standardized among HCS. • Lack of standardization of caregiver skills assessment. • Lack of standardization of professionals who assess eligibility. • Lack of standardization of the factors included in the eligibility assessment.	• Information systems do not communicate with other units. • Information system focused on the production of productivity data.
EXTERNAL FACTORS	Opportunities	• Possibility of requesting MHCT in the HCS that do not have it yet.	• Criteria for follow-up on HC1, HC2, or HC3 are established in an ordinance.	• National care network for chronic diseases.	• Participation in evaluative research and possibility of reflection on the results for changes in care practice	• Existence of an information system, the e-SUS HC, which can be adapted for communication.
EXTERNAL FACTORS	Threats	• The way care is organized is different in each HCS surveyed, denoting the absence of care protocols.	• Lack of flow of care for CSHCN in the territory.	• Inconstant communication between HCS and the health care network. • Discontinuation of follow-up in primary care of individuals followed in HCS. • Failure to agree on a specific flow for HCS with the emergency care network.	• Lack of self-assessment or even formal assessment from the State in relation to the services provided.	• Referral to home care depends on a time-consuming process. • Insufficient implementation of electronic and interconnected medical records.